Viewing entries tagged
North Carolina

Providing Measurable Value In CaseMix

How many therapy companies tell you they’ll help you improve your case-mix? How many tell you they’ll help you with ADL training? (Section G isn’t going away if you live in a case-mix state.) How many claim their clients have better reimbursement because of more complete documentation?

The answer is nearly all of us make those claims.

How many rehab companies follow through? How many are will to talk about proof that they follow through?

Let’s look at the data

The following information came from the state of North Carolina.

Broad River Rehab Customers have higher average ADL scores.

Statewide our customers average higher ADL scores. Why? Better documentation: We train our customer CNAs to recognize the work they do and document it appropriately. Our acuity isn’t higher but our percentage of correct documentation is.

We use on-site as well as mobile training to continue to reinforce Section G. Training isn’t an event, it’s a way of life in skilled nursing.


Broad River Rehab Customers have higher than average case-mix.

Proper documentation results in more accuracy. More accuracy in case-mix usually brings higher case-mix. It isn’t complicated but it requires sustained effort and focus.


Broad River Rehab Customers have higher than average Medicaid PPD.

This one should be obvious, but here it is. Our customers average about $10 per patient per day more.


But, correlation does not equal causation!

Right you are. Let’s look at a facility we started serving in Kentucky recently. (I am picking this one for convenience. The North Carolina buildings look the same.)

Case-mix went up.


Pay followed.


In this building, Broad River Rehab was the only change. We’ve seen this happen again and again.

If you think your provider is under-performing or isn’t responsive to your needs, we can talk about strategies to help improve. We can create an action plan to help with case-mix, star ratings, or quality measures. We can also help get you ready for PDPM.

Contact us today!

Q4 2018 North Carolina Medicaid Data

Q4 2018 North Carolina Medicaid Data

The data used to set rates for skilled nursing facilities in North Carolina for the final quarter of 2018 is here. We mine this data every quarter for not only trends but to also identify opportunities for us and our clients. I’ll summarize the major points here.

Overall case-mix index continues to climb. No surprise here. In each state that implements case-mix, the index tends to rise over time. North Carolina is no exception. (In states under case-mix for a very long time I’ve seen rehab as high as 70% for Medicaid.) As you can see in the image to the right (click to enlarge), the latest increase of 0.0088 is not the highest we’ve seen but is significant.

ADL scores continue to fall. This one is more surprising given how important ADL scores are. I don’t know what exactly drives this trend but I do have a suspicion. (click to enlarge) Don’t let this happen to you. ADL scores are important. Contact us for help training!

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Rehab continues to dominate the Medicaid categories. This quarter continues a trend of rehab taking more patients from Reduced Physical Function and others. What makes this quarter more interesting than most is for the first time in a while we have a reduction in extensive services. The Rehab category picked up an unusually high 4%. This is what is driving the increase in overall case-mix, especially in light of the overall reduction in average ADL scores.

The number of people on Medicaid in skilled nursing facilities remains largely unchanged. It’s been higher. It’s been lower. It’s only about 70 people lower than the average for the past 6 quarters.


We have data for your facility as well if you’d like to see how you building looks compared to averages or your nearby peers. Contact me for more information!

Trends in North Carolina Medicaid

Based on the latest data from the state of North Carolina, we can look at trends for Medicaid in skilled nursing in the state. Overall, average case-mix is up significantly, continuing a long term climbing trend. Keep in mind that in North Carolina, if the mean case-mix is increasing while your facility case-mix stays constant, your pay can go down. In other words, if the case-mix at your building is flat, your pay could be going down.


As you probably know, there are two main drivers for case-mix under the 34 grouper: therapy and ADL scores. We'll take a look at both.


After a couple of flat quarters, the percentage of residents in therapy has risen by one percentage point. This would certainly drive the case-mix index up.


ADL Scores

Over this same time period, average ADL scores declined slightly. In North Carolina average ADL scores tend not to move much. 


If you'd like to get a custom analysis of your Medicaid or a market analysis, contact us today!

Q1 2018 North Carolina Medicaid

Q1 2018 North Carolina Medicaid

“You can’t manage what you can’t measure”

The latest data from the state of North Carolina has been published. We spend considerable time carefully studying the data here at Broad River. It’s like a second report card that we get every quarter. (Obviously the most important report card comes from the customer.)

This data tells us how our customers compare to the rest of the state. It also tells us whether we’ve been successful in helping our customers reach their performance goals. We take it very seriously. 

Here are a few of the things we study:

1. - PPD by facility

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Contrary to what a lot of people believe, North Carolina Medicaid reimburses well IF you follow the rules and document the work you do. (More on this later) Accurate documentation means increased reimbursement. The first thing we look at is how our customer PPD compares to the state. We look at this number for each facility as well as overall. As you can see, for this quarter, Broad River customers averaged $188.48 dollars per patient day versus the state average of $178.96. That's $9.52 more each day on average. 

2. CMI versus PPD by Facility

PPD can be deceptive on some occasions so it’s important to look at the case mix index for each facility and compare it to the PPD. We expect our customers to be among the highest performers in the state. Any outliers get special attention. We want to understand the reasons behind the data. Many times we get good insights on ways to improve

You can see in this image we have facility with relatively high case-mix but lower than average PPD. This is a good opportunity to deep dive into the data and figure out why. There is also a building with lower than average CMI. That's a new customer so we'll be following up next quarter on that one.

3. ADL Scoring by Facility

We’ve never seen a facility that captures EVERY bit of the care they deliver to the resident. The higher the percentage of care you document, the higher your case mix. ADL scores are a great indicator of how well you are documenting. Broad River is always looking for innovative ways to help our customers do a better job capturing the critical work that staff in the building do. We do onsite training. We offer remote training. We have our employees document nursing ADLs when appropriate. We don’t just talk about helping you with ADLs, we actually try hard to fulfill that promise. 

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Broad River customers average more than a point higher than the rest of the state. This can be significant in terms of reimbursement.

4. Percent of Medicaid residents in rehab

This one sounds obvious but we’re always surprised how many companies don’t pay attention to it. A low percentage of Medicaid residents in rehab can indicate a staffing problem or other performance issue.

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Broad River averages a higher percentage of Medicaid patients on rehab and a lower percentage of residents in reduced physical function. 

These are just a few of the things we look at each quarter with regards to Medicaid. We strongly believe that to be successful, our customers have to be successful. That means working together as a team to make sure our residents get the highest quality care possible. It also means understanding how reimbursement works. It's not just about therapy.